NORTHWESTMICHIGAN HEALTH SERVICES, INC



NORTHWESTMICHIGAN HEALTH SERVICES, INC.

Migrant/Seasonal Farmworker Health Program

STANDING LAB ORDERS

for

Migrant Clinic Sites

PROBLEM:

When MFW clients present to NMHSI clinics, especially for initial visits at the beginning of the agricultural season, they often present with chronic conditions that require predictable laboratory profiles to assure adequate assessment of their condition(s). These clients are established diabetics and/or hypertensives who are seeking medication refills.

Occasionally, through the initial client assessment process, the clinic nurse will encounter findings suggestive of a chronic illness (examples: urine dip is positive for glucose and the client is verbalizing symptoms of diabetes) or evidence of an acute problem needing further laboratory evaluation (example: urine dip is positive for leukocytes and the client has symptoms suggestive of a UTI). Or,

Finger stick Hgb in a non-pregnant adult is indicative of anemia (see anemia protocols for values)

These situations present NMHSI staff with clinical dilemmas. We recognize that our clients have limited time and resources that make extra trips to our clinics burdensome, and so to address this NMHSI will establish standing orders for laboratory panels so that clients may receive the typically ordered profiles PRIOR to their first visit with the physician/mid-level provider. Hence the client will be enrolled, assessed per protocol, laboratory work will be ordered and drawn per these standing orders and the client will be given a subsequent appointment to see the physician/mid-level provider. This will facilitate prompt treatment of a variety of condition and minimize the burden of travel and time to NMHSI clients.

STANDING ORDERS:

To that end, the following are agreed to as appropriate lab tests for nurse staff to schedule prior to physician/mid-level appointments:

1. Adult clients with established HTN (or those with elevated BP on several visits who have not yet been diagnosed) presenting for the

initial assessment of the season (year):

▪ HTN Profile that includes the following:

TSH (only if new diagnosis of HTN)

Lipid Profile (triglycerides, HDL/LDL, cholesterol ratio)

Electrolytes

BUN/ Creatinine

AST/ALT

FBS

Routine U/A

EKG

2. Adults with established or suspected diabetes who present for the initial assessment of the season (year):

▪ Diabetic Profile that includes the following:

FBS

Hgb A1c

Lipid Profile (triglycerides, HDL/LDL, cholesterol ratio)

Electrolytes

BUN/Creatinine

AST/ALT

TSH

Urinalysis with micro albumin IF urine analysis by dip NEG for protein

Urine culture if indicated

EKG

3. The anemia workup ( for non-pregnant adults who have Hgb values below normal range as stated on reference chart) should include:

CBC with differential

Ferritin

Reticulocyte count

Total iron

Total iron binding capacity (TIBC)

PSA ( men over age 50 with anemia)

4. Adults who present for the initial assessment of the season (year) on an established anti-seizure regimen:

Anticonvulsant medication level (of the medication that the client is currently taking; i.e., Dilantin level)

CBC

Urine Analysis by dip

5. Adults who present for the initial assessment of the season (year) with an established thyroid-replacement regimen:

TSH (if abnormal, lab should automatically run a Free T4)

6. Adults/children who present with symptoms of urinary tract infection:

Urine analysis by dip

Microscopic urine and C&S if indicated by dip

7. For clients who present to the clinic pregnant and have not had a recent prenatal profile at another provider, and/or for the patient who has a positive urine Hcg test.

The Prenatal Profile should include:

Hepatitis B surface antigen

Rubella antibodies, IgG

ABO grouping

Rh factor

Antibody screen

RPR

CBC with diff and platelets

Approved by:

___________________________________________ ____________________

, MD (Medical Director) Date

___________________________________________ ____________________

(Clinical Services Director) Date

___________________________________________ ____________________

(Clinic Director) Date

(Prot.lab.orders)

Rev. 01/06

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download